Foreign bodies in the ear

Timothy C. Hain, MD at Chicago Dizziness and Hearing • Last edited: March 1, 2022

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Foreign bodies defined

Foreign bodies is the term that medical professionals use to describe stuff found in peoples ear canals that is not expected to be found there. For example, a pebble or a bug. Almost every ear doctor has lots of foreign body stories. A frequently repeated one has to do with small children, putting things into their ears (or nose). Interestingly, there are 84 papers in Pubmed with "Foreign body ear" in their title.

The most popular foreign body appears to depend on age and also location. Lotterman et al (2019) reported " While more common in pediatric patients, adults can also present with FB, most commonly an insect, in the external auditory canal. The most commonly removed FB tends to be beads (most common), paper/tissue paper, and popcorn kernels" . Shakeel et al (2013) noted that earplugs may be impacted into the external ear. In Ethiopia, Zewdu, D., et al. (2021). commented that "The most common type of FB was cereals or seeds. "

So what if there is a foreign body in the ear ?

  1. Like ear wax, foreign bodies can plug up the ear, causing hearing to be reduced, and a full feeling in the ear. An example of this might be someone with facial tissue wads in their ear canal.
  2. Foreign bodies may irritate the ear canal, or decay. This can result in a serious infection.
  3. Foreign bodies may cause medical professionals to dig around in the external canal with various tools, and cause more damage.

How does one know one has a foreign body

Direct vision is the easiest way. An otoscope is used to visualize it (or perhaps them).

How are foreign bodies treated

Basically they are removed. Using an examining microscope, small ones can sometimes be just grasped and removed with ear forceps. In children it is sometimes more difficult as the ear may be painful and the child does not want to hold still. These are best handled by an ear doctor (an otologist), who has the proper small tools, microscope, and access to an operating room with sedation if necesary.

Mingo et al (2019) reviewed 275 patients, and commented that "Rate of successful retrieval by ENT was significantly higher than by PCP (95.4% vs 75.0%) or by ENT after prior failed attempts (65.8%), but not when compared to removal in the ED (85.7%). "

Spherical foreign bodies may be difficult to grasp, and there has been some effort to develop techniques and tools for them specifically (e.g. Lineback, 1960)

Crockett et al (2011) described using the "Lasso technique".

Lou, Z. (2021). Commented that "The complication rate for non-specialist otologists using headlights was significantly higher than that for specialist otologists using endoscopes". Or in other words, it is harder to remove foreign bodies without an "endoscope". Perhaps Lou is referring to a microscope as an "endoscope" here, as standard technique is to use an examining microscope, and not to use a headlight/mirror system.

Lotterman and Sohal (2019) further commented "Certain types of FB, such as button batteries, do require urgent removal. However, for most inorganic objects there does not appear to a significant issue with the length of time the FB has been in the external auditory canal before attempted removal."

Woodley et al (2019) suggested that "cotton wool" was the most common foreign body seen in adults.

Rocks and Pebbles.

This situation is unusual, perhaps because what goes in, usually comes out pretty easily too.

We encountered a young man, 17 years old, who was completely deaf on one side. He had put a pebble into his ear canal when he was just 7 years old. His family doctor, decided to remove it with a tweaser, but it only became jammed in further. Eventually it was removed, but the ear drum was lacerated. The family doctor then treated this with gentamicin ear drops. These resulted in loss of both hearing and vestibular function on that ear.

Hearing aid parts, batteries

The little ends on the end of the tubes that go into the ear often fall off inside the ear canal. These are easily removed with proper tools.

Although one would wonder how a battery could fall into the ear, Nivatvongs et al(2015) commented on the difficult of removing these, and use of a magnetic telescope rod to remove one.

Manjunath, D., et al. (2021). Reported a case where ear mold impression material entered the middle ear through a perforation, and commented " It is essential that the audiologist perform a basic otological examination before prescribing a hearing aid and preparing an ear mould." This situation would seem to us to be easily avoided by looking at the external ear canal prior to making an ear mold. We have not encountered audiologists (so far) who don't do this, so the odds would seem pretty low.

Ventilation tubes

Often the tubes put into the ear drum to let air in (called PE tubes or ventilation tubes), fall out and just sit there in the ear canal. These are easily removed.

Candy

A patient told us, "I WAS TAKEN TO A CLINIC TO GET NERDS CANDY OUT OFF BOTH EARS (I WAS YOUNG AND ENCOURAGED BY OLDER SIBLING TO EAT NERDS THRU MY EARS)." The candy was dissolved using irrigation. Candy is generally not such a big problem because it can be irrigated out.

Beans, peas

Hard beans can be a particularly difficult problem because they may be difficult to remove, and they can decay in the ear canal, causing an infection. I was told a story by an otologist of a child who stuck a navy bean into his ear, which resided there for several months, and then began to decay and cause ear pain. This can cause a very severe infection in the side of the ear canal.

Davis (1918) reported removing a green pea from the middle ear.

Bugs

Of course, bugs can decide to explore an ear canal, or be placed in there by a curious child. I have had several "bug" ear cases. These things are common but there are a few case reports anyway (e.g. Bail, 1949)

A 12 year old young man told his mother that "a bug crawled into my ear and never came out". His mother was dubious. Eventually, she brought him into the clinic, and sure enough, there was a (dead) bug plastered up against the ear drum by ear wax. This was easy to remove with warm water.

Another bug story involved a blind adult, who wasn't sure, but said she thought that she felt a bug crawl into her ear. She was right and the bug, fortunately no longer living, was taken out with the help of a microscope and ear forceps.

Alazzawi et al (2016) reported a tick embedded in the ear.

Of course, we all know that cats and dogs can get "mites" in their ears. This is more of an infestation or infection than it is a foreign body. This probably occurs in people, but rarely. Mites (demodex) are found in roughly 6% of normal human ears and are more common in ears where a local steroid preparation has been used. (Cevlik et al, 2014)

Alex et al (2021) reported a fatal case: "Her history was insignificant except for having multiple left ear syringing for an insect removal 10 days before onset of her current symptoms. MRI of the brain with gadolinium revealed left cavernous sinus thrombosis with acute infarcts in the left frontal lobe. Culture grew broad aseptate fungal hyphae. Despite starting on antifungal therapy, she succumbed to her illness." This is very unusual but does illustrate the need to take action.

 

Kleenex tissue

Sometimes people put facial tissue into their ears for a variety of reasons, perhaps to keep cold air from bothering them. This can build up over time, and cause a similar problem as ear wax. This is best taken out with a examining microscope and proper small tools. Woodley et al (2019) suggested that "cotton wool" was the most common foreign body seen in adults.

Ear plugs

As mentioned, Shakeel et al (2013) noted that earplugs may be impacted into the external ear.

Boules Quies

We were sent a report about wax ear plugs, "Boules Quies", that he used for noise protection. He wrote "Wax ear plugs (mostly old ones) become dry and I got ear obstruction by a small piece of dry black wax ear plug (Boule Quies). It had big consequences on my balance. It took nearly 6 months before I visited an ENT specialist who just removed it."

We would not expect problems with ear plugs made of foam or silicone, as they would be unlikely to disintegrate into small pieces.

Odd case reports

If you have interesting foreign body ear canal stories, feel free to email me and if I think they are interesting and appropriate, I will add them to this page !

thain@dizzy-doc.com

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